title: The diagnosis and treatment of giant cell arteritis.
abstract: BACKGROUND
  Giant cell arteritis (GCA) is the most common systemic vasculitis in persons aged 50 and above (incidence, 3.5 per 100,000 per year). It affects cranial arteries, the aorta, and arteries elsewhere in the body, e.g., in the limbs.
  
  
  METHODS
  We selectively review the pertinent literature, including guidelines and recommendations from Germany and abroad.
  
  
  RESULTS
  The typical symptoms of new-onset GCA are bitemporal headaches, jaw claudiacation, scalp tenderness, visual disturbances, systemic symptoms such as fever and weight loss, and polymyalgia. The diagnostic assessment comprises laboratory testing (erythrocyte sedimentation rate, C-reactive protein), imaging studies (duplex sonography, high-resolution magnetic resonance imaging, positron-emission tomography), and temporal artery biopsy. The standard treatment is with corticosteroids (adverse effects: diabetes mellitus, osteoporosis, cataract, arterial hypertension). A meta-analysis of three randomized controlled trials led to a recommendation for treatment with methotrexate to lower the recurrence rate and spare steroids. Patients for whom methotrexate is contraindicated or who cannot tolerate the drug can be treated with azathioprine instead.
  
  
  CONCLUSIONS
  Giant cell arteritis, if untreated, progresses to involve the aorta and its collateral branches, leading to various complications. Late diagnosis and treatment can have serious consequences, including irreversible loss of visual function.
authors.affiliation: University Eye Hospital Freiburg, Germany. thomas.ness@uniklinik-freiburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Ness
authors.forename: Thorsten A
authors.initials: TA
authors.lastname: Bley
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: Peter
authors.initials: P
authors.lastname: Lamprecht
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D013700:Giant Cell Arteritis / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones